Topical corticosteroid therapy for corneal toxicity from systemically administered cytarabine

Area of Science:

• Oncology
• Ophthalmology
• Pharmacology

Background:

• High-dose cytarabine is a key chemotherapy for leukemia.
• Systemic cytarabine can cause significant ocular toxicity, including corneal damage.
• Preventative strategies for cytarabine-induced corneal toxicity are needed.

Purpose of the Study:

• To evaluate the efficacy of topical prednisolone phosphate in preventing corneal toxicity associated with high-dose cytarabine therapy.
• To assess the impact of corticosteroid prophylaxis on the incidence and severity of ocular side effects.

Main Methods:

• A double-masked, randomized trial involving 11 leukemia patients refractory to conventional therapy.
• Patients received high-dose cytarabine and daunorubicin, with either 1% prednisolone phosphate or placebo eyedrops.
• Ocular toxicity was monitored and compared between treated and placebo eyes.

Main Results:

• Ten of 11 patients experienced a significant reduction in corneal toxicity in the corticosteroid-treated eye (P < .0005).
• Placebo-treated eyes showed median onset of pain, photophobia, and tearing at 6.5 days, resolving in about a week.
• Topical corticosteroids markedly decreased the intensity and duration of ocular side effects.

Conclusions:

• Topical corticosteroid prophylaxis is effective in preventing and reducing corneal toxicity from systemic high-dose cytarabine.
• Ophthalmologic prophylaxis should be considered for patients undergoing this intensive chemotherapy regimen.
• This intervention improves patient tolerance to cytarabine treatment by mitigating ocular side effects.